Archive for October 2016

Councillor Smithers: Hmm... it looks like we underestimated the uptake of the new green-waste permit, Sir. You know, the one that you brought in because green-waste services were paid for out of the Council Tax, supplemented by the County Council. We have a surplus of £165,000.

Mr Burns: Excellent! Just give me a moment to rub my palms together and to don my Face of Avarice.

Councillor Smithers: Shall we give them a partial refund, Sir?

Mr Burns: No. It's my money now. MINE, I tell you!

Councillor Smithers: Shall we reduce the price for next year, and hence attract more people to the scheme?

Mr Burns: Hell no!

Councillor Smithers: Then what do you suggest we do, Sir?

Mr Burns: Put the windfall to a different scheme, one which they might not support, and where they'll never see any benefit.

Councillor Smithers: Will there be anything else, Sir?

Mr Burns: Yes. Crow about it in the local free rag. We ought to keep the proles informed, it's good politics.

Councillor Smithers: Should we issue an apology or express some gratitude, Sir?

Mr Burns: Over my dead body, Smithers!

I don't mind paying for the service, but I do object to paying over the odds for it. I also object to paying into the Developing Communities Fund without my consent while others who didn't pay for a bin-permit won't have to do so.

Over the last two days this whole affair has become a lot more bizarre...

Yesterday I attended my monthly out-patient consultation at LRI. Good basic blood results, the Hb had climbed back to 148, so no anaemia due to the first venesection. Curiously, I was given no result for ferritin, which I thought was strange as that's the only thing they are actively treating at the moment. The consultant was oddly reluctant to discuss it, so naturally I pressed the matter 🙂

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He said that there wouldn't be much effect after just one venesection and that they would check it after 6 or so of them. Not good enough, I said, telling him of the grief that I would suffer when SWMBO asked for the non-existent test-result, and that we weren't going to be happy waiting about 30 weeks to find out if the procedures were working. After me threatening to give SWMBO his email address he relented and said that they would do a test at the next monthly consultation.

I told him again that his "6 weekly" instruction on the venesection referral form had been "interpreted" by me and by LGH as "one a week for 6 weeks" and that the second "bleed" was provisionally booked for today (21st October), 11 days after the first one. He said that he had intended it to mean "1 every 6 weeks", I told him that if that was what he meant, he should have written that instead. I told him that I felt fine, and pointed out that according to his own results my Hb had recovered within only 10 days, so there was no sign of venesection-induced anaemia. Grudgingly he said that "1 every 4 weeks" would do, and then after a bit of muttering and keyboard-mashing he changed that to "1 every 3 weeks". I asked if he wanted me to cancel the provisional for today but he didn't say yea or nay.

So today I made the executive decision and went to LGH for the second bleed.

As previously reported, the first venesection was done on 10th October. On that day, before they drew the blood, they took a mandatory sample so that they could measure the ferritin (yeah, it's not rocket-science) and the Hb. Today I got the result of that test...

Ferritin: 998 × 10-6 g/L

So it had gone down by 677 × 10-6 g/Lwith no intervention whatsoever between 22nd September and 10th October... just 18 days.

And nobody has yet been able to explain how or why.

I suspect that at least one of the test results is wrong. That, or at least one of the test results is someone else's result. Don't snigger - it's happened to me at least twice this year. I know that I'm often over-cynical, but either scenario might explain the consultant's reluctance to disclose a ferritin result yesterday.

Regardless, LGH proceeded to take another pre-venesection sample and hooked me up to a drain-bag. While that was going on they made me another appointment for 6 weeks hence. After I queried that, the Ward Sister quizzed me regarding the confusing "6 weekly" thing. When I told her that I'd discussed it again with the consultant and that he'd clarified it... and then changed it... and then changed it again, she said that she wouldn't sanction any more bookings for me until the whole sorry mess was sorted out officially and to her satisfaction. She was on the blower to Haematology in seconds flat.

Eventually she returned. 1 every 3 weeks. Official. So now I have 2 appointments at 3-week intervals.

Sorted. But it shouldn't have taken over 4 weeks to sort out and they shouldn't have used me as a go-between.

It'll be another 3 weeks until I discover the ferritin level from today's pre-venesection sample at LGH, and 4 weeks for the ferritin level from the next out-patient consultation at LRI. Those results might just depend on which way the wind was blowing, what colour socks I was wearing and which other patient's tests were being done at the same time.

Moon-gazing again last Sunday... playing around with a colour video camera on the 6" R-C... 17 clips each of 250 frames, stacked with AutoStakkert!2, coaxed into one mosaic using iMerge (see previous post), tarted up with Photoshop CS3.

The result is better than expected.

Feel free to click on it to see the full version, but be aware that it might take a while to load - it's about 12Mb:

After losing the first referral form asking for a series of venesections to be started within 2 weeks of 22nd September, LRI raised a replacement on October 4th. On the 7th of October the nice nurse where they do the blood-letting (Ward 1 LGH) called me and we had a chat about it. She thought that I had raised Hb and needed it reducing, I had to tell her that my Hb was fine and that I need the ferritin (FT) reducing without reducing the Hb to a level where I would become anaemic. She asked me what my FT level was and was mildly taken aback when I told her "1675". She said that the info wasn't clear regarding the frequency and number of treatments - I remember the consultant writing "6 weekly"* on the original and told him at the time that I thought it was a tad vague. Clearly the info on the replacement referral form also leaves a lot to be desired.

That first session took place today, so it was late.

According to LGH each bleed should reduce the ferritin by 30-50 × 10-6 g/L, that's for the Haemochromatosis patients that they usually deal with, they hardly ever have patients with acquired iron overload due to chemo and multiple Hb transfusions. 30-50 × 10-6 g/L isn't much compared to 1675 × 10-6 g/L, so at that rate it'll take plenty of venesections to get things fixed.

LRI want to space them out because a higher frequency means risking anaemia which would not be a good thing. Venesections remove ~9% of the Hb, and Hb levels don't recover naturally at much more than, in my case, ~10 g/L per week.

So, LRI are referring me to LGH for a series of venesections to get the FT down to ~500, a level which they consider to be OK and at which they would stop. To reduce it all the way down to the top-limit of 200 would take many more venesections. Now, depending on * below, 6 bleeds could take 6 or 36 weeks, and, say, 20 bleeds could take 20 or 120 weeks, which is probably longer than I have left! Some authorities (at LGH) insist that it should be brought down to 50 and then be controlled between 50 and 200... good luck with that 🙂

Anyway, we're one down, several more to go. LGH are hedging their bets and have made another appointment for me next week, the day after my next out-patient consultation at LRI.

* As predicted, the "6 weekly" thing was interpreted in different ways. LGH, where they do the procedure, interpreted it as once a week for 6 weeks, the Haematology Nurse Specialist at LRI thinks that the consultant intended it to mean once every 6 weeks. I find it totally bizarre, it's no way to specify a course of treatment.

This post was edited on 21st October 2016 and again on 15th January 2017 - the nice chart has been removed because it was based on incorrect information (thanks for the duff info, University Hospitals of Leicester NHS Trust!).

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